{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUE  E LEGARD","gend":1,"add":"5307 LEE HWY STE C","city":"TROUTVILLE","state":"VA","zip":"24175-9998","dob":"1979-02-25","age":"","mstatus":"","insh":"2476724*01","cliId":"","pno":5403535536,"cno":5403535536,"email":"","ename":"","eno":"","pphy":"SADIQ, SAIMA MD","ppno":5409771436,"pcpadd":"37 LAYMANTOWN RD","pcpcity":"TROUTVILLE","pcpstate":"VA","pcpzip":"24175-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Healthcare Corp","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409774230,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F33.2","G47.00","F41.0","F43.10","F11.20","F15.20","NO DATA","S76.011A","F17.200","E03.9","Z79.890","M25.551","V89.2XXS","R20.0","G89.29","F41.9","Z86.16","R41.89","M54.31","S90.32XA","H16.142","H04.123","G56.03","H10.31","M54.41","W19.XXXA","R05.9","U07.1","R41.82","F15.10","F17.290","Z79.899","R41.0","R94.31","F90.9","F90.0","E34.8","R68.89","M25.562","M62.81","R26.2","R26.89","R26.81","G89.4","G57.00","M54.12","M17.10","M47.817","Z79.891","M53.3","M50.00","M54.16","M47.816","M51.26","Z51.81","S73.101A","V49.50XA","R10.9","R15.1","M25.511","S96.912A","G47.19","R53.83","M51.16","H16.041","H18.823","R48.8","Z20.822","F23.","F84.0","Z82.49","Z88.0","Z91.09","E89.0","Z87.442","Z90.49","E87.6","Z01.419","Z12.31","Z12.4","Z11.51","N83.202","T26.62XA","R05.1","J01.90","J34.9","M54.2","N93.0","N83.292","H16.103","J06.9","G93.41","F11.90","R10.31","Z01.411","M50.10","M48.02","M19.011","M22.2X2","J02.9","G43.009"],"date":["2023-04-13","2023-04-13","2023-01-19","2023-01-19","2023-01-19","2023-04-16","2022-09-25","2023-04-05","2022-12-12","2023-03-11","2023-03-11","2023-03-11","2022-12-20","2022-12-14","2022-12-30","2022-12-20","2022-12-30","2022-12-20","2023-03-28","2022-12-22","2023-02-20","2023-01-14","2023-01-14","2023-01-26","2022-06-02","2022-06-02","2022-06-02","2023-01-19","2023-01-09","2022-10-05","2022-10-05","2022-10-03","2022-10-03","2022-12-21","2022-10-04","2022-10-04","2023-01-19","2023-03-28","2023-01-13","2023-04-05","2023-04-05","2023-04-05","2023-04-05","2023-04-05","2022-07-20","2022-06-20","2022-12-23","2022-06-20","2022-06-20","2022-07-20","2022-06-20","2022-06-20","2023-04-03","2022-07-20","2022-07-20","2022-07-20","2022-12-12","2022-12-12","2023-02-02","2023-02-02","2023-03-06","2023-02-20","2023-03-23","2023-03-23","2022-05-23","2022-09-23","2022-09-07","2022-10-06","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2023-03-28","2022-10-05","2022-10-05","2022-10-06","2023-01-12","2023-01-12","2023-01-12","2023-01-12","2023-03-21","2023-01-28","2023-02-21","2023-02-21","2022-12-30","2023-03-06","2022-12-12","2022-12-12","2022-09-07","2023-01-19","2022-10-06","2022-10-06","2023-03-11","2022-11-16","2023-04-03","2023-04-03","2023-04-03","2023-03-07","2023-01-19","2023-03-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","43598029690","PREGABALIN","200 MG","90","Select","Select",""],["","65162044210","MECLIZINE","TAB 25MG","30","Select","Select",""],["","24979053301","GUANFACINE","TAB 1MG ER","30","Select","Select",""],["","00406052301","OXYCOD\/APAP","TAB 10-325MG","90","Select","Select",""],["","43547028210","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","57844011501","ADDERALL","15 MG","60","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","90","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","65862067705","ALPRAZOLAM","0.5 MG","90","Select","Select",""],["","68382011514","RISPERIDONE","2 MG","30","Select","Select",""],["","00555901658","SPRINTEC 28","TAB 28 DAY","28","Select","Select",""],["","47781017801","AMPHET\/DEXTR","TAB 15MG","60","Select","Select",""],["","67877026218","RIZATRIPTAN","10 MG","9","Select","Select",""],["","54092039101","ADDERALL XR","CAP 30MG","30","Select","Select",""],["","00574403105","TOBRA\/DEXAME","SUS 0.3-0.1%","5","Select","Select",""],["","00536589588","NICOTINE TD","DIS 14MG\/24H","28","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","68180097001","LEVOTHYROXIN","TAB 112MCG","90","Select","Select",""],["","52817018000","CLONIDINE","TAB 0.1MG","10","Select","Select",""],["","65162041503","BUPREN\/NALOX","SUB 8-2MG","13","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","23155002401","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","62332051805","TOBRAMYCIN","SOL 0.3% OP","5","Select","Select",""],["","60505056000","OFLOXACIN","0.3 %","5","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","00172392660","DIAZEPAM","TAB 5MG","6","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00143980350","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","00603533715","PREDNISONE","5 MG","21","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","20","Select","Select",""],["","00378181110","LEVOTHYROXINE SODIUM","112 MCG","90","Select","Select",""],["","47781017801","DEXTROAMPHETAMINE-AMPHETAMINE","15 MG","60","Select","Select",""],["","70436003901","GUANFACINE HCL ER","1 MG","30","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","70010075401","METHOCARBAMOL","500 MG","30","Select","Select",""],["","00093083205","CLONAZEPAM","0.5 MG","60","Select","Select",""],["","57664050289","TIZANIDINE HCL","2 MG","90","Select","Select",""],["","43547028110","ESCITALOPRAM OXALATE","10 MG","30","Select","Select",""],["","23155002401","BUSPIRONE HCL","10 MG","60","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","14","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","65162019050","NAPROXEN","500 MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","1","Select","Select",""],["","00536589588","NICOTINE PATCH","14MG\/24HR","28","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}